Application of Three-dimensional CT Angiogram in Perioperative Evaluation for Patients Underwent Transapical Aortic Valve Implantation——The Initial Experience from West China hospital_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANGSi-meng ¹ , CHENGWei ¹ ,  SUNJia-yu ¹ , ZHUDa ² , CHENYu-cheng ³ , SHIYing-kang ² , GUOYing-qiang ²

1. Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
2. Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
3. Department of Cardiology, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

SUNJia-yu, Email: sjy080512@163.com

Keywords：

3D-CT; Transcatheter aortic valve implantation; Perioperative evaluation

DOI：

10.7507/1007-4848.20160061

Video：

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Objective To introduce the role of three dementional computed tomograph (3D-CT) for patients underwent transcatheter aortic valve implantation (TAVI) procedure in perioperative evaluation. Methods From April 2014 to June 2015, we retrospectively analyzed clinical data of 28 patients with severe aortic stenosis underwent successful TAVI procedure using new second-generation device, who were enrolled in this study including 12 males and 16 females at mean age of 72.8±4.5 years. We used 3D-CT to get the perioperative relative evaluation, including valve morphology and calcification degree, annular diameter, aoronary ostium height, ascending aorta, aortic sinus diameter, left ventricular-aortic angle, optimal intraoperative angiogram projection angle. Based on the evaluation by 3D-CT image, the prosthesis size, balloon size, best intraoperative imaging projection angle and approach of apex were then chosen. Results All patients with severe aortic stenosis underwent successful TAVI procedure with mean logistic Euro-SCORE I:26.2%±7.9%. CT image revealed that mean aortic annular diameter was 24.6±1.8 mm with mean valve prosthesis size 25.8±1.1 mm and pre-dilation balloon size 23.1±1.2 mm and 76.8% patients were of tricuspid aortic valve with severe calcification and 25% patients were of asymmetric calcification. Optimal intraoperative angiogram image was achieved in 92.9% patients with the help of preoperative CT image. There was a statistic difference in mean transvalvular gradient after valve implantation (54.1±15.3 mm Hg vs. 13.1±8.5 mm Hg, P<0.05). And there was no mortality or severe complication postoperatively. Conclusion 3D-CT image palys an important role during perioperative evaluation of TAVI procedure and it can be helpful for Chinese doctors to operate TAVI successfully.

Citation： WANGSi-meng, CHENGWei, SUNJia-yu, ZHUDa, CHENYu-cheng, SHIYing-kang, GUOYing-qiang. Application of Three-dimensional CT Angiogram in Perioperative Evaluation for Patients Underwent Transapical Aortic Valve Implantation——The Initial Experience from West China hospital. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(3): 258-263. doi: 10.7507/1007-4848.20160061 Copy

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2.	Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
3.	Tamburino C, Capodanno D, Ramondo A, et al. Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation, 2011, 123(3): 299-308.
4.	Gurvitch R, Wood DA, Tay EL, et al. Transcatheter aortic valve implantation: durability of clinical and hemodynamic outcomes beyond 3 years in a large patient cohort. Circulation, 2010, 122(13): 1319-1327.
5.	Toggweiler S, Leipsic J, Gurvitch R, et al. Percutaneous aortic valve replacement: vascular outcomes with a fully percutaneous procedure. J Am Coll Cardiol, 2012, 59(2): 113-118.
6.	Hayashida K, Lefevre T, Chevalier B, et al. Transfemoral aortic valve implantation: new criteria to predict vascular complications. J Am Coll Cardiol Intv, 2011, 4(8): 851-858.
7.	Ye J, Cheung A, Lichtenstein SV, et al. Six-month outcome of transa-pical transcatheter aortic valve implantation in the initial seven patients. Eur J Cardiothorac Surg, 2007, 31(1): 16-21.
8.	Takagi H, Umemoto T, Grou A. A meta-analysis of adjusted obser-vational studies for mortality in transapical versus transfemoral aortic valve implantation. Int J Cardiol, 2014, 174(1): 165-170.
9.	Lardizabal JA, O'Neill BP, Desai HV, et al. The transaortic approach for transcatheter aortic valve replacement: initial clinical experience in the United States. J Am Coll Cardiol, 2013, 61(23): 2341-2345.
10.	陆清声, 裴轶飞, 吴宏, 等. 首批球扩式经导管主动脉瓣膜置换术10例. 中国胸心血管外科临床杂志, 2015, 22(11): 1039-1043.
11.	Bloomfield GS, Gillam LD, Hahn RT, et al. A practical guide to multimodality imaging of transcatheter aortic valve replacement. JACC Cardiovasc Imag, 2012, 5(4): 441-455.
12.	Kurra V, Schoenhagen P, Roselli EE, et al. Prevalence of significant peripheral artery disease in patients evaluated for percutaneous aortic valve insertion: preprocedural assessment with multi-detector computed tomography. J Thorac Cardiovasc Surg, 2009, 137(5): 1258-1264.
13.	Joshi SB, Mendoza DD, Steinberg DH, et al. Ultra-low-dose intraar-terial contrast injection for iliofemoral computed tomographic angiography. J Am Coll Cardiol Img, 2009, 2(12): 1404-1411.
14.	Piazza N, de Jaegere P, Schultz C, et al. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv, 2008, 1(2): 74-81.
15.	Messika-Zeitoun D, Serfaty JM, Brochet E, et al. Multimodal assess-ment of the aortic annulus diameter: implications for transcatheter aortic valve implantation. J Am Coll Cardiol, 2010, 55(3): 186-194.
16.	Kasel AM, Cassese S, Bleiziffer S, et al. Standardized imaging for aortic annular sizing implications for transcatheter valve selection. JACC Cardiovasc Imag, 2013, 6(2): 249-262.
17.	Zhu D, Chen Y, Zhang J, et al. Transapical implantation of a new second-generation transcatheter heart valve in patients with pure aortic regurgitation: a preliminary report. Interact Cardiovasc Thorac Surg, 2015, 20(6): 860-862.
18.	Zhu D, Chen Y, Guo Y, et al. Transapical transcatheter aortic valve implantation using a new second-generation TAVI system-J-Valve TM for high-risk patients with aortic valve diseases: Initial results with 90-day follow-up. Int J Cardiol, 2015, 199(4): 155-162.
19.	Zhu D, Hu J, Meng W, et al., Successful transcatheter aortic valve implantation for pure aortic regurgitation using a new second generation self-expanding J-Valve TM system-the first in-man implantation. Heart Lung Circ, 2015, 24(4): 411-414.
20.	Cheng J, Chen M, Zhu D, et al. Successful trans-apical aortic valve implantation for a high risk patient with aortic stenosis using a new second-generation TAVI device-J-Valve TM system. J Cardiothorac Surg, 2015, 10(5): 5.

1. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 2010, 363(17): 1597-1607.
2. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
3. Tamburino C, Capodanno D, Ramondo A, et al. Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation, 2011, 123(3): 299-308.
4. Gurvitch R, Wood DA, Tay EL, et al. Transcatheter aortic valve implantation: durability of clinical and hemodynamic outcomes beyond 3 years in a large patient cohort. Circulation, 2010, 122(13): 1319-1327.
5. Toggweiler S, Leipsic J, Gurvitch R, et al. Percutaneous aortic valve replacement: vascular outcomes with a fully percutaneous procedure. J Am Coll Cardiol, 2012, 59(2): 113-118.
6. Hayashida K, Lefevre T, Chevalier B, et al. Transfemoral aortic valve implantation: new criteria to predict vascular complications. J Am Coll Cardiol Intv, 2011, 4(8): 851-858.
7. Ye J, Cheung A, Lichtenstein SV, et al. Six-month outcome of transa-pical transcatheter aortic valve implantation in the initial seven patients. Eur J Cardiothorac Surg, 2007, 31(1): 16-21.
8. Takagi H, Umemoto T, Grou A. A meta-analysis of adjusted obser-vational studies for mortality in transapical versus transfemoral aortic valve implantation. Int J Cardiol, 2014, 174(1): 165-170.
9. Lardizabal JA, O'Neill BP, Desai HV, et al. The transaortic approach for transcatheter aortic valve replacement: initial clinical experience in the United States. J Am Coll Cardiol, 2013, 61(23): 2341-2345.
10. 陆清声, 裴轶飞, 吴宏, 等. 首批球扩式经导管主动脉瓣膜置换术10例. 中国胸心血管外科临床杂志, 2015, 22(11): 1039-1043.
11. Bloomfield GS, Gillam LD, Hahn RT, et al. A practical guide to multimodality imaging of transcatheter aortic valve replacement. JACC Cardiovasc Imag, 2012, 5(4): 441-455.
12. Kurra V, Schoenhagen P, Roselli EE, et al. Prevalence of significant peripheral artery disease in patients evaluated for percutaneous aortic valve insertion: preprocedural assessment with multi-detector computed tomography. J Thorac Cardiovasc Surg, 2009, 137(5): 1258-1264.
13. Joshi SB, Mendoza DD, Steinberg DH, et al. Ultra-low-dose intraar-terial contrast injection for iliofemoral computed tomographic angiography. J Am Coll Cardiol Img, 2009, 2(12): 1404-1411.
14. Piazza N, de Jaegere P, Schultz C, et al. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv, 2008, 1(2): 74-81.
15. Messika-Zeitoun D, Serfaty JM, Brochet E, et al. Multimodal assess-ment of the aortic annulus diameter: implications for transcatheter aortic valve implantation. J Am Coll Cardiol, 2010, 55(3): 186-194.
16. Kasel AM, Cassese S, Bleiziffer S, et al. Standardized imaging for aortic annular sizing implications for transcatheter valve selection. JACC Cardiovasc Imag, 2013, 6(2): 249-262.
17. Zhu D, Chen Y, Zhang J, et al. Transapical implantation of a new second-generation transcatheter heart valve in patients with pure aortic regurgitation: a preliminary report. Interact Cardiovasc Thorac Surg, 2015, 20(6): 860-862.
18. Zhu D, Chen Y, Guo Y, et al. Transapical transcatheter aortic valve implantation using a new second-generation TAVI system-J-Valve TM for high-risk patients with aortic valve diseases: Initial results with 90-day follow-up. Int J Cardiol, 2015, 199(4): 155-162.
19. Zhu D, Hu J, Meng W, et al., Successful transcatheter aortic valve implantation for pure aortic regurgitation using a new second generation self-expanding J-Valve TM system-the first in-man implantation. Heart Lung Circ, 2015, 24(4): 411-414.
20. Cheng J, Chen M, Zhu D, et al. Successful trans-apical aortic valve implantation for a high risk patient with aortic stenosis using a new second-generation TAVI device-J-Valve TM system. J Cardiothorac Surg, 2015, 10(5): 5.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of Three-dimensional CT Angiogram in Perioperative Evaluation for Patients Underwent Transapical Aortic Valve Implantation——The Initial Experience from West China hospital

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